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Contact Information

EAU CLAIRE COOPERTIVE HEALTH CENTER, INC.
338 E COLUMBIA AVE
SUITE B
LEESVILLE, SC29070-9285
 Phone: 803-532-1580
 Fax: 803-532-3832
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Federally Qualified Health Center (FQHC)

261QF0400X B4[14] Federally Qualified Health Center
Indicates primary specialty

NPI Profile & details for EAU CLAIRE COOPERTIVE HEALTH CENTER, INC.

NPI # 1336460948
LBN Legal business name EAU CLAIRE COOPERTIVE HEALTH CENTER, INC.
Authorized official DELGADO CANTAVE - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 06/17/2010
Last updated 10/10/2022 - About 4 years ago
Identifiers
SC Medicaid CBP018
SC Medicaid FQC031
SC Medicaid FQC123
SC Other 4350 MEDICARE PART B
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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